Prevention of accidental removal of tube and drains: A case report

Anandhi Sathiyakumar1*, Deepa 2, Stella Towncent 3

1Nursing Director, Kauvery Hospital, Alwarpet, Tamilnadu, India.

2 Nursing Superintendent, Kauvery Hospital, Alwarpet, Tamilnadu, India.

 3Clinical Nurse Educator, Kauvery Hospital, Alwarpet, Tamilnadu, India.

*Correspondence: M: 979086166; Email: [email protected]

Background

Study Title: PARTicipate to Anticipate (PART – Prevention of Accidental Removal of Tubes & drains)

Objective: To evaluate the impact of PART Bundle for patient with lines and tubing among staff nurse.

Aim: To prevent the accidental removal of tubes and lines and therefore enhancing the patient safety.

Introduction

Accidental removal of tubes and drains by means any unintentional pulling or accidentally coming out may cause severe damage to the internal organs or skin. This even results in irreversible injury / incident and it is important to implement preventive measures to ensure the patient safety

Root Cause Analysis

Identified the Possible causes of accidental removal of tubes and drains done through Gemba and data analysis. The findings are plotted using ishikawa diagram

Root cause reveals- Lack of awareness regarding practice of marking lines & Tubes

Date Analysis and Interpretation

Standardization

It is done by developing PART Bundle care and implemented audit tool for PART bundle care adherence

Conclusion

  • After implemented these measures, we analyzed the findings and found a remarkable positive results.
  • There was a notable improvement in the rate of nurses’ compliance to the PART Bundle check list that translated into a clear reduction in the accidental removal of lines and tubes such as drain tube and nasogastric tube and initiation of timely intervention to prevent life threatening event.
  • Nurses are empowered to take timely effective action after consulting with the on duty clinicians.
  • Patients and attendant are engaged to explain the importance of immediate intervention to prevent deterioration of the condition and patients safety.

Reference

  • Lorente L, Huidobro MS, Martín MM, Jiménez A, Mora ML. Accidental catheter removal in critically ill patients: a prospective and observational study. Crit Care. 2004 Aug; 8(4):R229-33. doi: 10.1186/cc2874. Epub 2004 Jun 2. PMID: 15312222; PMCID: PMC522842.]
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Ms. Anandhi Sathiyakumar
Nursing Director

Ms. Deepa
Nursing Superintendent

Ms. Stella Towncent
Clinical Nurse Educator

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